Emdeon Business Services: Efficient Solutions
Health Solution Spotlight
Written by Amanda Gaines   
Tuesday, 01 April 2008
Emdeon Business Solutions: Efficient Solutions - Health Executive - Red Coat Publishing
By taking the paper out of the process, this revenue cycle solutions company brings efficiency to its customers. George Lazenby outlines the strategy.
Premier Business Partners:

Cognizant
United Envelope
XK3 Graphic Services
Few healthcare consumers understand the administrative complexities facing them down the road when they gain the majority of the responsibility for their healthcare payments. Thankfully, Tennessee-based Emdeon Business Services understands and is working to simplify the administrative complexities of providers and payors before the consumerism of healthcare takes yet another step forward.

George Lazenby, CEO - Emdeon Business Solutions: Efficient Solutions - Health Executive - Red Coat Publishing
George Lazenby, CEO
“The vision of the company is simplifying the business of healthcare by automating manual, unnecessary, and often expensive processes,” said George Lazenby, CEO. “We bridge the communication between payors and providers along the patient encounter.”

The company began as a claims transaction processor 15 years ago, when most providers sent claims to their payors on paper. Today, Emdeon electronically processes one out of every two of the 1 billion commercial claims in the country.

“The claims market is now 75% electronic,” said Lazenby. “We helped drive that adoption to significantly reduce costs in the healthcare space.”

Four-pronged focus
Emdeon’s network consists of more than 1,200 payors and 300,000 providers. From its claims transaction roots, the company has expanded the capabilities of its network to many other transaction types, including real-time and electronic remittances and payments. To support the patient encounter, Emdeon provides accurate information through its relationships with payors and providers.

At the point of scheduling and patient registration, patients provide their demographic and insurance information to their providers. The company’s patient access solutions allow the provider to immediately and accurately verify patient benefits and coverage. Physicians can electronically run an inquiry to the payor, and, in seconds, they get a response telling them whether the patient is eligible for the procedure, what the patients’ co-pays and deductibles are, and other benefit-specific information.

“We serve providers with accurate information, allowing them to assess how they will be paid for their services,” said Lazenby. “Because the transaction happens electronically, payors don’t have to field a phone call from the providers, which means their call center costs go down. As the system is automated, the rate of accuracy also increases.”

Once the patient is seen and charges are collected, Emdeon’s services support electronic claims submission and claims management. Customers can submit their claims through Emdeon’s proprietary applications or through a direct interface to their practice management applications that capture the claims electronically, validate them, and review for any missing information or clinically specific edits. According to Lazenby, claims are edited to ensure that when payors receive the claims, they are paid accurately and in a timely manner.

“The provider benefits because the claim goes to the payor electronically versus printing on paper and mailing,” he said. “The payors benefit because the claims they receive from our systems are accurate. They can go right into their adjudication system and get paid without physically working the claim.”

The next step in the process is remittance management. Once the claim has been adjudicated by the payor system, payors determine payment and write a check to the provider. The check is then sent to the provider with a remittance, which explains what the physician will be paid and why. Providers can take the information and automatically post it in their patient accounting system, eliminating the manual process of hand-keying data.

Emdeon gives the providers the necessary information— the details of why and how the claim was paid by the payor. Additionally, if providers don’t understand why they haven’t been paid on a claim, they can run a transaction (claim status) rather than calling the payor to get the status.

“By adding real-time capabilities to our network, we’ve evolved the network to further streamline and automate this process,” Lazenby said. “For the payor, we can distribute the explanation of benefits back to the patient. We are the largest provider of this service, and also of patient billing services, in the country.”

Further evolution
Emdeon delivers nearly 700 million patient statements a year. Providers send Emdeon an electronic file of all patient bills, and the company prints and mails them in a consistent and easy-to-understand statement to improve collections. Emdeon also offers electronic payment capabilities to its providers so patients can log onto a secure Web-based solution and make payments online rather than writing a check and mailing it to the provider.

As Medicare and Medicaid strive to reduce their overall costs, they are lowering their reimbursement rates to providers. As commercial plans follow suit, shifting more of the costs to consumers or patients, providers feel the squeeze. While consumerism continues to be adopted in the marketplace, more of the providers’ payments will shift to the patient. This is a problem, since collections are not generally a strong suit of providers.

“Collections represent about 10% of providers’ overall revenues today; they also represent about half of the write-offs providers do on an annual basis,” said Lazenby. “We’ve been positioning our company to help our provider customers with this shift.”

In December, the company announced its acquisition of IXT Solutions, a patient billing and payment solutions innovator. The acquisition enables Emdeon to provide its customers online patient billing, e-cashiering, return mail management, and lockbox (secure and automated payment processing) services.

“It creates an almost self-service environment,” said Lazenby. “Consumers are more likely to make the payment, and it makes providers more efficient at collecting a difficult part of their reimbursement.”

The acquisition also marks Emdeon’s full evolution from only claims management, remittance services, and patient eligibility and access to one that covers the entire provider revenue cycle. On the payor side, the acquisition means Emdeon is more than an electronic claims company; it can also help reduce the paper flow, enhance electronic capabilities, and speed up the payment distribution process. Moving forward, Lazenby expects the company to further evolve to decision support.

“As our systems become more intelligent, we’ll put more information in the hands of our customers to help them run their businesses,” he said. “The company is again evolving to decision support and workflow tools, helping to use those transactions so our clients, whether payor, provider, or pharmacy, will be more efficient. As we evolve to decision support, we’ll help our customers manage their business cohesively rather than managing each increment of the business.”
 
< Previous Story   Next Story >